Closure of the hysterotomy
Following the decision to proceed to hysterectomy, the umbilical cord is cut as short as posible, ligated with a free tie and placed back into the uterine cavity via the fundal incision.
The hysterotomy is then closed in sufficient layers to achieve good haemostasis with a monofilament suture to avoid tearing the myometrium.
Pre-conservative (deliberate placental retention) management
The uterus is closed in 3 layers (as for a 'classical' incision and the woman is counselled postnatally that she must not labour in future).
Three layer closure for Conservative Management
To prevent the suture from tearing through the myometrium it can help if the assistant brings the edges together along the incision ahead of the suturing (with a blunt needle).
This should not be done in a hurried or emergency situation and communication is vital between surgeon and assistant as great care must be taken to avoid a needle stick injury.
Bulk haemostatic closure before a hysterectomy